No abstract

This study examines the local memory of atmospheric and oceanic changes associated with a tropical cyclone (TC). The memory is quantified through anomalous maximum potential intensity (MPI) evolution for 20 days prior to the arrival of a TC through 60 days after the TC passage. The local MPI weakens and is not restored to the evolving climatology until well after the TC has departed. Stabilization occurs through warming of the atmosphere and cooling of the ocean surface on different time scales. The time scale of MPI stabilization following TC passage is approximately 30–35 days for a tropical storm to 50–60 days for a category 3–5 hurricane, with significant storm-specific and basin-specific variability. The atmospheric stabilization (warming with respect to SST) begins with TC arrival and continues for approximately 7–10 days after passage, when the troposphere cools below normal. The rewarming of SST and the subsequent rewarming of the atmosphere occurs within approximately 35 days for all intensities, despite a positive (weakened) MPI anomaly through two months. This suggests that the atmosphere retains anomalous warmth beyond what can be attributable to sensible heating from the rewarmed SST. The maintenance of a positive MPI anomaly beyond 35 days is thus attributed to a feedback on larger scales that requires considerable further research. A TC’s passage through a region does not always lead to a weakening of the MPI. In regions poleward of the sharp SST gradient, the MPI one month after TC passage is often several millibars stronger than climatology. There are also mesoscale regions of destabilization one month after TC passage that may result partially from salinity changes driven by oceanic mixing as well as changes in precipitation and evaporation.

Objective To assess the effectiveness of safety advice and safety equipment in reducing unintentional injuries for families with children aged under 5 years and living in deprived areas. Design Randomised controlled trial. Setting 47 general practices in Nottingham. Participants 3428 families with children under 5. Intervention A standardised safety consultation and provision of free and fitted stair gates, fire guards, smoke alarms, cupboard locks, and window locks. Main outcome measures Primary outcome measures were whether a child in the family had at least one injury that required medical attendance and rates of attendance in primary and secondary care and of hospital admission for injury over a two year period. Secondary outcome measures included possession of safety equipment and safety practices. Results No significant difference was found in the proportion of families in which a child had a medically attended injury (odds ratio 1.14, 95% confidence interval 0.98 to 1.50) or in the rates of attendance in secondary care (incidence rate ratio 1.02, 0.90 to 1.13) or admission to hospital (1.02, 0.70 to 1.48). However, children in the intervention arm had a significantly higher attendance rate for injuries in primary care (1.37, 1.11 to 1.70, P = 0.003). At both one and two years' follow up, families in the intervention arm were significantly more likely to have a range of safety practices, but absolute differences in the percentages were relatively small. Conclusions The intervention resulted in significant improvements in safety practices for up to two years but did not reduce injuries that necessitated medical attendance. Although equipment was provided and fitted free of charge, the observed changes in safety practices may not have been large enough to affect injury rates.

Dyspnea is a common symptom in ED patients contributing substantially to ED, hospital, and ICU workload. It is also associated with significant mortality. There are a wide variety of causes however chronic disease accounts for a large proportion.